Chantier Politique

February 20, 2016

English Edition, No. 5

Health Care Workers Fight for Their Rights and Health Care as a Right

Second Anniversary of Adoption of Bill 10 and the
Anti-Social Restructuring of Health Care in Quebec

Health Care Workers Fight for Their Rights and Health Care as a Right
Second Anniversary of Adoption of Bill 10 and the Anti-Social
Restructuring of Health Care in Quebec


Paramedics On Strike - An Important Fight Against Downward Pressure on the Conditions of All


Health Care Workers Fight for Their Rights and Health Care as a Right

Second Anniversary of Adoption of Bill 10 and the
Anti-Social Restructuring of Health Care in Quebec

"We finance the private sector with public funds for the delivery of public services" - A hospital worker in the Estrie Region

February 6, 2017 marked the second anniversary of the passage of Bill 10, An Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies. This Quebec anti-social health care restructuring bill is a pillar of the "Barrette Reform," named after the Liberal government's Minister of Health, Gaétan Barrette. It is a law about management structure and governance that centralizes health care facilities within with mega-establishments, where boards of directors’ members are mainly appointed by the Minister himself. The Minister may also dismiss boards of directors as he sees fit. The law facilitates the further privatization of the health care system through the centralization of decision-making and by placing the system's resources in the hands of the Minister.

Chantier politique recently interviewed a hospital worker from the Estrie region who has been active for many years in fighting for health care as a right as well as in defence of workers' rights.

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Chantier politique: Thank you for speaking with us on the significance of the reform, of which Bill 10 is an essential part. Can you begin by telling us what you consider are the essential features of the law, whose second anniversary is being marked?

Worker from the Estrie region: Bill 10 includes the abolition of regional health agencies and the creation of Integrated Health and Social Services Centres (CISSS). In the case of the Estrie region, which includes the University Hospital Centre (CHU) affiliated with the University of Sherbrooke, the new establishment is the Centre for Integrated Health and Social Services of Estrie-CHUS (CIUSSS-CHUS). The Centre has merged 15 establishments, including the Centre for Health and Social Services (CSSS), the Youth Centre and others, into a single regional establishment covering the entire region.

These new centres are managed by a board of directors composed, as the Minister himself has pointed out, of people highly qualified in management -- high-caliber administrators such as are found in big business. Most board members are chosen by the Minister, who also appoints the Chief Executive Officer (CEO). Prior to the bill’s adoption parliamentary committee hearings were held, where very few individuals and organizations supported the bill. Approximately three-quarters of witnesses opposed it, viewing it as a form of centralization that would further distance decision-making centres from the population.

Regional health agencies were doing useful work by conducting population-based studies on health care and social service needs, making recommendations on those needs as well as on budget distribution. They were a place where the population, by way of various organizations, could express their needs and expose shortcomings in the delivery of services.

Bill 10 is characterized by an authoritarian management style, in the sense that upper management decides and the others implement. If you recall the Minister's statements, directed towards local administrators at the time, were about the risk of dismissal if they spoke out against the reform. With that style of management the opinions of others are not taken into consideration. We see it every day. Exchange and discussion with management are information sessions; one can give his or her opinion but it is not taken into account. As far as the unions are concerned, there is still the possibility of raising concerns, but this takes place with people who must wait for a directive from the centre before responding, with many issues remaining unresolved, to the extent that human resource managers have been dubbed "mailboxes."

The network is organized based on the whims and plans of the Minister of Health. Those who intervene, whether they be managerial, professional or other, must submit to the Minister's dictate. The views of workers, professionals and even managers on how services should be organized to meet the needs of the population are negated.

Emphasis is placed on the hospital sector, which means that all aspects of social services, such as youth centres, rehabilitation facilities for physical, addiction and intellectual impairment related and other problems are increasingly being left out. Resources destined for social services are being cut. This began before the Barrette reform, which has accelerated the process. When you look at the structure that is being put into place and the budgets that are being allocated, the Barrette reform has resulted in a dramatic increase in the speed at which these services are being scrapped. This is not what is being said, which is one of the problems. They are moving extremely quickly without defining their objectives. It is on the ground that we find out that we have neither the resources nor the personnel required to provide the service it is our mission to deliver. The Minister claims that the purpose of his reform is precisely to provide the services, while he does the opposite of what he says. When he is told about the failures of the reform, he claims that they are due to the resistance of those who do not want to take the measures required to provide the service.

The Minister's approach is strictly clinical. You broke your leg because of alcohol addiction: you go to the hospital, your leg will be taken care of, but your addiction (the root cause) will not be treated. You contracted food poisoning because you cannot afford to buy quality food: your intoxication will be treated and then you will be sent back to the to very situation that resulted in your contracting food poisoning in the first place.

In essence, the concern is a financial one. The Ministry of Health has a budget of over $40 billion. Hospitals are where most of that money is spent, which is also where the private sector makes the most profits through the sale of appliances and equipment -- which is where the volume is. When you read the trade journals, they talk about the health care market, the health care industry. That's how management circles speak about the health care network. It's $40 billion in public funds that should serve the needs of the population. It is being managed from a commercial perspective, as a source of profit.

Chantier politique: The centralization of decision-making and resources, as is being done through Bill 10, serves the further privatization of the health care system.

Worker from the Estrie region: Absolutely.

For example, before the holidays it was announced that around $100 million would be invested in health care, of which $60 million would be set aside for residential and long-term care facilities (CHSLDs). The Minister explained that the $60 million was to hire attendants for CHSLDs in order to optimize existing CHSLD beds. He also explained that the budget would not suffice to meet the needs and that external resources would be called upon to provide the missing beds. External resources refer to seniors' homes, private residences, which receive public funding. For example, they receive public funds to treat people with Alzheimer's, although normally these people would be in CHSLDs, in the public sector. One can see therefore that the private sector is financed through public funding to deliver public services. And the attendants who are hired by the private residences are underpaid -- they receive $12 per hour on average and are not provided all the training that is required in the public sector. The profits of private operators are guaranteed to the detriment of seniors.

Large multinationals and large private monopolies operate in the private residence sector. This is where the network's greatest privatization is found. The reform is accelerating the process to an even greater extent. Seniors, youth centres, persons with disabilities are considered by the reform as excess. Based on the system's logic, seniors no longer generate any income and are looked upon as an opportunity to siphon off revenue accumulated through their contribution during their entire working life.

Another example is the government's announcement of a healthy eating policy in CHSLDs. The government set up a group of specialists whose mandate was to establish a standard menu for CHSLDs for the coming months and years. This means the standardization of supply, the same type of food quality everywhere, the same supplier, the standardization of large kitchen production. Only large hospital centres have kitchens with surplus production capacities. Small centres do not have those capabilities. Who will offer these services? -- Probably the big private food service companies. The Minister has said that in order to implement the program, he will have to smash the resistance of the unions.

We are confronted with the increased privatization of the health care system. This is the general direction that is being taken.

The key issue with the reform is: who are the economy and the state serving? They must serve the legitimate needs of the people, of society. Until that issue is resolved, we will continue to be confronted with a deterioration of living and working conditions. Workers must resist, elaborate alternatives to the extent possible, and defend the right to health care and social services that meet the needs of society. This will be done in myriad ways, with due consideration given to all fronts of struggle.

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Paramedics On Strike - An Important Fight Against Downward Pressure on the Conditions of All


Paramedics and other health care workers demonstrate in Quebec City, October 27, 2016.

Close to 1,000 paramedics, members of the Brotherhood of Pre-hospital Workers of Quebec (FTQ) went on strike February 2, in many cities in Quebec. Three days later, some 960 paramedics members of the Federation of Health and Social Services (FSSS-CSN) employed by Urgences-Santé in Montreal and Laval joined the strike. The FSSS has about 3,600 workers in the pre-hospital sector and strike actions have been held recently in Quebec City and Sherbrooke, and more are expected to be held in Quebec North Shore and Lower Saint-Lawrence.

Quebec paramedics have been without a contract since March 31, 2015. They are demanding significant improvements in their working conditions, which have deteriorated over the years. The working conditions are also those of the delivery of services so vital to the health of the population.

They seek a reduction in their workload, which has become quite impossible to manage with the number of calls and the increased intervention time while the number of staff and vehicles has not kept up. Because of the deteriorating conditions, people who require paramedics have suffered cardiac arrest and other serious issues while waiting longer than they should for an ambulance to pick them up. In this context, psychological exhaustion has become common among paramedics.

Workers are calling for the abolition of on-call schedules in the regions, where paramedics are on duty seven days in a row for 24 hours a day followed by seven days off. These schedules, besides destabilizing the lives of the workers, mean that the waiting time following a call is greater as the workers first have to leave their homes to pick up an ambulance.

Paramedics are demanding wage increases that bring them on par with those of the public sector and improvements to their pension plans. Due to the particularly challenging conditions in which they work, many ambulance attendants have to retire earlier than workers in other occupations and request arrangements to do so without penalty.

The demands of the paramedics are just and consistent with the important work they do for the people and the value they bring to society. Their demands are aimed at halting the deterioration of services under the anti-social offensive of successive governments.

After two years without a contract, normative aspects are largely settled but the monetary clauses are going nowhere. The employers, be it Urgences-Santé, which is a state-organized-enterprise, or the Corporation des services d'ambulance du Québec (CSAQ) representing the vast majority of private, not-for-profit and cooperative ambulance companies outside Montreal and Laval, all claim they do not have a mandate to negotiate monetary issues. The stated reason is the government's refusal to uphold its responsibility. Health Minister Gaétan Barrette of the Couillard government expressed this himself in a particularly cynical way in April 2016. He announced his Ministry was withdrawing from the bargaining table, except with regards to negotiation of the pension plan. Barrette blustered about an overhaul of service contracts that the government has with various employers, a redesign to consider them subcontractors, which would negotiate independently with the workers. In this way the government wants to weaken the united stand of paramedics and make them deal with all the different subcontractors who are all state sanctioned and financed enterprises. The government knows full-well the integrated nature of pre-hospital services and the overriding responsibility of the state, which is responsible for funding all paramedic companies, but is putting on this act to attack ambulance service workers.

The workers find themselves in the absurd situation where their employers say they do not have a mandate to negotiate and the government says it is up to the different subcontractors to negotiate. The service contracts expire on April 1, 2017 and the employers' bodies are saying the amount the government is allocating to them is being drastically reduced. For this reason they say they cannot make any wage offers for the last three years of a five-year agreement. Within this anti-social atmosphere, ambulance workers are told wage increases will only occur if they give monetary concessions on other aspects of the contract, such as holidays and vacation time.

Minister Barrette's dictate to divide the sector into contracting companies is meant to drive down the wages and working conditions of paramedics, both urban and remote, and dismantle the uniform terms of employment workers had achieved in earlier struggles. This will only weaken the system and cause harm both to workers and the public. Ambulance attendants are not willing to accept this retrogression. They demand that the government stop this irresponsible cynical manoeuvring and negotiate agreements with the workers that are acceptable to them and improve the situation in the health care system.

"We want to conclude a collective agreement for the people we represent, with the priorities we have put forward," Jean Gagnon, the representative of the FSSS-CSN pre-hospital sector, told Chantier politique. "Employers, including Urgences-Santé, must have negotiating mandates so that we can sit down and settle once and for all. It is up to the Ministry to ensure that we can negotiate with employers because our employers are only intermediaries in this process. This has been going on for two years. We had no choice but to go on strike."

During their strike, paramedics continue to provide emergency services to the population. However, ambulance vehicles will no longer be posted on-site at sporting or artistic events and will dispatched only if required. Paramedics will no longer perform their administrative duties (such as filling out forms for billing patients) and will reduce their ambulance maintenance work to essentials.

The struggle of paramedics is an important feature of the workers' movement for a pro-social Quebec to resist downward pressure on society and deserves the support of all.

(Photos: Chantier politique, V. Fradet, CSN, FTPQ-592)

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